Dental Tribune Asia Pacific Edition

Dental TribuneAsia Pacific Edition | 12/201512 TRENDS&APPLICATIONS Having the ability to take a patient frompoint A topoint Zinfewerap- pointments within one’s practice allows one to position oneself as a provider that can fulfil patient’s surgical and restorative needs. With the proper training, a dental provider may provide extraction, grafting and implant placement within one appointment at one location. Not only does this allow the reduction of the number of visits for the patient, but this type of service also helps the patient stay within his or her budget.Most importantly,this enables the dental provider full control of the surgical and prosthetic outcome. Depending on the patient’s de- sires, the clinical conditions of the oral environment and the skills of the dentist, the dentist may choose to extract teeth, level bone, and graft with simultane- ous dental implant placement. In this case, a patient in his mid- sixties presented to the office withdiscomfortowingtomultiple rampant caries and generalised advanced periodontal disease (Figs.1&2).Havingalreadyvisited multipleprovidersforaconsulta- tion, he was very frustrated with the treatment options offered with varying treatment plans that were segmented into dif- ferent disciplines. Since many of these options did not com- plement the other, the patient decided to come to us for full treatment after being referred by one of our patients who had un- dergone a Total Dental Solutions Reconstruction. Before the surgical appoint- ment, a CBCT scan was taken to accurately plan treatment for this case to make certain that no complications would arise from completing all of the procedures (extract, graft and implant place- ment) in the Total Dental Solu- tions Reconstruction protocol. coDiagnostiX software (Dental Wings)wasusedthrough3DDiag- nostix virtual assistance to pre- cisely plan the placement of six Engage (OCO Biomedical) dental implants in the maxillary arch, as well as seven Engage dental implants in the mandibular arch using CT-based surgical pilot guides(3DDiagnostix;Figs.3&4). The final treatment plan was fixed bridges on implants in the maxillary and mandibular arches. Engage implants were se- lected (Fig. 5) because I have per- sonally experienced their high implant stability at placement, which is a critical success factor during the early healing process of osseointegration with these types of cases. With the combina- tion of its patent-pending Bull Nose Auger tip and Mini Cortic-O Thread, this implant system of- fers practitioners a bone-level implantwithhighinitialstability for selective loading options. In fact, the Engage implant body creates a tapping pattern when threaded for an enhanced me- chanical lock in the bone. Other dental implant systems with ag- gressive threading may include, but are not limited to, Nobel- Active (Nobel Biocare), SEVEN (MIS Implants Technologies), ETIII(Hiossen),I5(ABDental)and AnyRidge (Megagen). For effectiveness and greater proficiency during the Total Den- tal Solutions Reconstruction pro- cedures, intravenous sedation should be performed. Not only does it make the appointment easier, but patients also prefer to have the treatment completed in one visit. Since the patient is sedated, a mouth prop is needed tokeephisorhermouthopen.Be- cause of this, teeth are extracted in quadrants, starting from the upper left to the upper right and then down to the lower right and lower left. This allows great time- savings, as it is easier to keep the patient’s mouth open and be able to proceed around the arches safely. Once the teeth have been extracted, the tissue has to be re- flected in order to seat the bone- level surgical guides and fix them with their respective retention pins. Using these pilot surgical guides, the osteotomies for the implants were begun with a 1.95 mm pilot drill utilising the Mont Blanc surgical handpiece (Anthogyr) and Aseptico surgical motor (AEU 7000) at a speed of 1,200 rpm with copious amounts of sterile saline (Figs.6 & 7). Paralleling pins were placed in the sites of the osteotomies to confirm the accuracy of the sur- gical guide and radiographs were taken to check the angulations of the pins within the maxilla and the mandible. Once the osteotomies were complete, an 7 8 9 10 11 12 4 5 6 1 2 3 Fig.1: Retracted pre-op view.—Fig.2: Pre-op panoramic radiograph.—Fig.3: Maxillary virtual treatment plan.—Fig.4: Mandibular virtual treatment plan.—Fig.5: Engage dentalimplant.—Fig.6:Asepticosurgicalmotor.—Fig.7:Usingthepilotguide.—Fig.8:OsstellISQunit.—Fig.9:GoodFitInstantCustomTray.—Fig.10:Full-archimpression.— Fig.11: Post-op panoramic radiograph.—Fig.12: Retracted post-op view. “An increasing number of patients are presenting to dental practices who seem to require this type of reconstruction.” Efﬁciently delivering full-mouth reconstructions By Dr Ara Nazarian,USA 789 101112 456 123

Dental Tribune Asia Pacific Edition

Pages Overview